When does a tremor indicate a more serious problem? What examination or diagnostics are needed?
—Aleaxandra Flerchinger, MSN, FNP, Polson, Mont.

Tremors are the most common of all movement disorders. They are classified as either static, meaning they occur even when the patient is at rest, or action, presenting only with intentional activity.Obviously, a thorough neurologic exam is required. Almost as important is a careful history. Onset, timing, characteristics, and especially family history should be explored. Depending on your location and available resources, testing should include thyroid studies, comprehensive metabolic panel, and erythrocyte sedimentation rate at a minimum. Brain CT with contrast and MRI are usually included in these workups, as well as an electroencephalogram. If all these are normal, the tremor is most likely benign, but tremors always warrant a neurology consult to verify findings.
—Sherril Sego, MSN, FNP (113-13)

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